Summary

Facial pain syndrome in the distribution of ≥1 divisions of the trigeminal nerve.

Diagnosis is clinical, with a history of paroxysms of sharp, stabbing, intense pain lasting up to 2 minutes.

First-line therapy is medical, to which the majority of patients are partially responsive.

Surgical/ablative therapies are reserved for refractory cases.

Ablative therapies can cause facial sensory loss and are associated with a high recurrence rate; however, they are relatively non-invasive and carry minimal risk of severe morbidity/mortality.

Microvascular decompression has few long-term sequelae and well-established efficacy but has a potential risk of major morbidity.

More research on neurostimulation is needed to define its role in the treatment of trigeminal pain.

Definition

Trigeminal neuralgia (TN) is a facial pain syndrome in the distribution of ≥1 divisions of the trigeminal nerve. It is characterised by some combination of paroxysms of sharp, stabbing, intense pain lasting up to 2 minutes and/or a constant component of facial pain, without associated neurological deficit. The pain can be precipitated by trigger areas or factors, and repeat attacks are typically stereotyped in the individual.